Disordered Eating: Control or Controlled?

Catherine was having an affair. It was her little secret. No one else was let in on it, not even her best friend. Her husband didn't know, of course. Every time she would meet with her lover in a quiet room in an out-of-the-way place where no one knew her, she knew it was wrong. But her lover met needs she had in a way nothing else seemed to. Even though she would feel dirty afterwards, it didn't stop her from going, and she would devise elaborate lies to cover up what she was doing.

Even when they were apart, Catherine's mind was on her beloved: when they would meet, what they would do together, how it would feel when it was just the two of them alone again. As she thought of their time together, she could almost begin to hate what they did enough to stop it. But life without her lover seemed like no life at all.

It might have been different if Catherine's lover had been another person, but Catherine was a bulimic, and her lover was food -- preferably sweets, chocolate in particular. She would find a safe place, away from prying eyes, and consume mass quantities of cakes, cookies, doughnuts, and desserts of any kind. Shoving them down her throat as fast as she could, she felt as if her hunger was just on the verge of being satisfied. It was always on the verge, though. She would stuff more and more down in the hope of achieving fulfillment.

Afterwards she would panic. Finding a bathroom, she would turn on the water full blast to hide the noise and stick her finger down her throat.

Something inside Catherine's mind drove her to act out this destructive scenario over and over with her body. Not content to keep the abusive effects to itself, the mind was determined to take the body along with it.

Bulimia, anorexia, and compulsive overeating all have their roots in abuse of some kind. They derive from an inappropriate use of control. The bulimic and the compulsive overeater are out of control. The compulsive overeater is a binge eater, like the bulimic, without the subsequent purging. For the anorexic, the problem isn't lack of control, it is the obsessive use of control -- specifically control over one's consumption of food.

No one starts out life deciding they are going to spend years stuffing sweets and junk food down their throats only to throw it up or flush it out of the body with laxatives and diuretics. No one starts out life deciding they are going to drink only water and take four bites of food each day to force their body to shrink. No one starts out that way.

Somewhere along the line, messages are given to all these individuals about their self-worth, their looks, their weight, and their value to themselves and others. Those messages, delivered under the battering of emotional abuse, gave birth to the destructive practices of the eating disorder.

If you are living with disordered eating:

Are you willing to work with mental health and healthcare professionals to address this condition, or do you feel you need to get better by yourself?

Have you tried to get better by yourself in the past? If so, was this successful?

If you are not willing at this time to work with mental health or medical professionals, can you identify why?

If working with your current mental health or health-care professional is not producing positive results, are you willing to seek help elsewhere?

While you might choose to ignore the signs of emotional abuse in your life, often you have no choice but to pay attention to the physical ones. When the body speaks, it's time to listen. By being alert to one part of yourself, your body, and the effects you experience, you can be led to discover the truth about your whole self -- emotional, physical, and relational.

I would dearly love to see the data that reflects the dangerous opinions in this synopsis. Anyone up to date with current research knows that the genetic link with eating disorders is very real, hence the huge gene study going on at the moment. Does this gentleman also believe that cold mothering causes autism? Join us in the 21st century, please. We may have global warming, but we know that mental illness is not caused by abuse!

This article is riddled with inaccuracies, misconceptions and is written, I suspect, from self-interest.

Eating disorders are biologically based brain disorder. They come as the result of a perfect storm of genetics, biology and environmental factors. Gregory Jantz does not "believe" this. He believes that people choose to have an eating disorder. Incidentally he regards it is a sin to remain eating disordered. He also believes that all eating disorders stem from abuse and that the main perpetrators of this said abuse are the family. There is NO evidence to back these claims - no citations, no studies. It is "his" experience. This is a man who also sells "metabolic" supplements - please read Ben Goldacre Bad Science for a sensible discussion on "metabolic supplements".

His list of tools needed to overcome an eating disorder includes a Bible, a set of crayons, a notebook and magazines you can cut pictures out of. My, oh my, why is all this money being spent researching the most lethal psychiatric disorder in the DSM when all you need to do is blame your parents, stop committing sins and get some new crayons?

It is time to stop people using excuses such as God, self-blame, parent-blame and other non-evidence based "claims" to make money for themselves. NOW is the time to campaign for better treatment and research for people who are lethally sick through no fault of their own.

For up-to-date evidence based information and resources please visit the F.E.A.S.T. website (www.feast-ed.org).

When my daughter was diagnosed with severe anorexia on admission to our Children's Hospital. The psychiatrist sat my husband down and let us know that she had severe anorexia, it was a serious mental illness, the only research currently suggests that it has a heritability factor and some association with anxiety and perfectionistic traits. There was no evidence of any association with abuse, trauma or 'wanting to be thin'. Made sense to us as our daughter was anxious since a baby, very perfectionistic and she got sick after a trip trekking in Nepal where she lost 4 kg.
asserting all EDs have a root in abuse sends sufferers and their carers down fruitless rabbit warrens and can compromise their recovery and indeed their life. I can't believe ill informed material like this is even allowed to be published.

Oh dear. What a load of codswallop!
The previous comments cover much of what I have to say on this matter and far more eloquently than I could have!
Just to add, I have been fighting anorexia and bulimia for over 20 years now and I really thought we were moving past this damaging blame culture re. eating disorders. The biggest shame is that there are still folk out there who hold these views and it muddies the water for those who are striving to recover and those who care for them.
I second the recommendation of the F.E.A.S.T website and also of the forum of the site Around the Dinner Table.
I also recommend Carrie Arnold's website Ed Bites as a fantastic resource for all of the up to date research on eating disorders. Plus a read of Carrie's book Decoding Anorexia, which I would recommend the author of this article might want to get a hold of.

This blog post is just plain crazy, not sure if the submitter is living in the 21st century, or stuck back in time. Very dangerous nonsense to be spewing out, as if he has some sort of authority. Psychology Today should really spend the time to eliminate such psychobabble. I fear that there are actually people out there who will read his blog post as ED Gospel (yup, I can apply a little Biblical note too), His views are just plain HOGWASH!

I am so very thankful that we found excellent care, that was based on current science, for our then 12 year old, who had had a happy, abuse free, normal, love filled life, but ended up with an ED.

Firstly I want to say that I am a Born Again Christian and have been for the best part of 20 years. I have a daughter that was diagnosed with anorexia 2 years ago. I am very happy to say she is well on the way to recovery now but it is not because of the "treatment" you are offering. Quite the opposite actually. When we realised our daughter was sick she had only lost 5kgs but that was enough to trigger the eating disorder. I prayed hard about what treatment to use with her because we really had no idea what to do and were terrified. God lead us to Maudsley FBT and after two years my daughter has all but recovered. She is a healthy weight, she maintains it herself and she is a normal teen again. She needed FOOD first and foremost. Her brain was too sick to reason with until she was weight restored and even though we prayed with her and she continued to go to church she was only really able to commence personal therapy when her weight was stable for some time.

My daughter was never abused, she was breastfed for over 2 years, we homeschooled her, she attended church from the womb, our family has always had a healthy attitude to food and I have never EVER dieted. My daughter has always been a perfectionist and high achiever. All it took was her losing 5kgs quickly to trigger her anorexia. I write all of this because I really want people to know that there is effective therapy available to treat eating disorders that is based on actual research. Nobody asks to get an eating disorder. It is a biological brain disorder that has a strong genetic link. It is NOT a sin to have an eating disorder any more than it is a sin to have Cystic Fibrosis, Epilepsy or PTSD. Please do not make parents or sufferers feel guilty for something that is largely beyond their control.

Other commenters have pointed out the glaring inaccuracies in this piece and the fact that the conclusions in this article are not based on current research. Given that publishing information like this is harmful, what responsibility does Psychology Today take for allowing this piece on it's site? It's horrifying to see once-respected publications publish out-dated dreck in the service of clicks and advertising dollars. They are actual people--patients with eating disorders and their families--who may read this and believe all or pieces of it--much to the detriment of the treatment of their disease.

If I, a layperson, have access to medical journal articles by the most respected players in the field and can find out what evidence-based research has to say about eating disorders, why would PT publish an intellectually lazy, self-serving piece such as this?

The utter nonsense, non evidence based rhetoric spewed by the author leaves me stunned and terribly saddened at the thought of those parents who may be concerned an eating disorder is developing or has had a child diagnosed with an eating disorder potentially coming across this dreadfully damaging article.

In the event any parent, caregiver or patient stumbles across this article by this misinformed man spewing such dribble; please allow me to copy and paste the following letter, written to the Executive Director of Families Empowered and Support of Eating Disorders (F.E.A.S.T.) by the Director of the National Institute of Mental Health, Dr. Thomas Insel! (

It is indeed frustrating that so many professionals continue to promote a “blame and shame” approach to people with mental disorders. This is especially unfortunate in the treatment of eating disorders, in which the “experts” have long blamed parents, while recent evidence demonstrates the effectiveness of parent-centered treatment (see attached from Locke et al), suggesting that parents may be the solution not the problem. Families and people challenged with mental disorders increasingly find reassurance in the emerging research that addresses these as brain circuit disorders (see attached from Scientific American) but many professionals, who have no training in neuroscience, still find a neurobiological approach to mental disorders as misguided and frankly alien to all of their experience. You may want to watch Good Morning America tomorrow. Congressman Patrick Kennedy is scheduled to be interviewed about his campaign to reduce stigma of mental disorders by framing these illnesses as brain disorders. Perhaps, as you quote in your e-mail, this effort will fail, but in an earlier decade, focusing on the medical basis of cancer and AIDS helped us out of the blame and shame phases of these disorders.

"Bulimia, anorexia, and compulsive overeating all have their roots in abuse." I can't believe someone who supposedly is an eating disorder specialist would say such a thing. This may be true for some, but certainly not all. To say so serves no one. Shame on Jantz for promoting such an outdated and mistaken idea. Scientists are finding out more and more about brain chemistry and eating disorders. Jantz needs to do his homework before he's allowed to write articles on such an important subject and complicated disease.

I'd like to add that abuse may be in the form of “unmet emotional needs.” We understand there may be some associated controversy, but it's important to note ours is a whole-person approach, which does acknowledge the biological issues -- an approach that has proven invaluable to the 35,000 patients we've treated over the past 30 years. Our model is not that of blame nor shame, rather getting to the root cause or causes, whatever they are in nature.

"Unmet emotional needs" is a very broad category indeed, so to put it under the heading of abuse sounds weak and self-serving. You could talk to every teacher, coach, friend, etc. my daughter had over the 17 years before she became anorexic and they would tell you she appeared to have a suburban childhood of the sort movies are made--no, we're not a perfect family, but we are happy, loving and fully functional. My daughter had no trauma or abuse. She was a happy, social, fun, quirkily organized child, they youngest of four. Her treatment agrees with the description I gave of our family.

If either my daughter or I were to have read and believed what you have written, it would have been counterproductive to her recovery. And since she left for college today and has been eating independently, with no ED thoughs or behaviors for several months that would be a true shame.

If you want to write about eating disorders, there are fascinating studies happening all the time. There are amazing stories about the strong families who do Family Based Treatment. Please don't twist or add to the suffering of eating disorder patients and their families just because it suits your need to sell people a cure for their "abuse."

Are you now redefining what the word "abuse" means? Last I checked in most dictionaries, I've never seen a reference to "unmet emotional need". The words "mistreat, misuse, ill treat" are more in line with the definition.

Let's be honest here Doc, most of us who have responded here really believe that you are trying to peddle your various publications and other aids, and little of this is about evidence based treatment of Eating Disorders. You cannot possibly treat the "whole person" if you are not first re-feeding to the point where the brain can think and respond in a rational/healthy manner. A brain disordered from lack of nourishment, is damaged. Food, food, food, and set the mumbo-jumbo aside. Again, shame on Psychology Today for not vetting your blog post.

As a parent two years ago who was deep in the trenches with a newly dx. 12 year old ED child, I am so happy that when at that time I did not come across a blog post like this one. Thankfully we had access to doctors who are up to date with the latest forms of treatment and knowledge about what an ED is and what it is definitely not. Included in that is causation. Yes, I very much resent your suggestions of abuse as the underlying issue behind an ED. Oy vey!

Would that paradigm for treatment work with cancer? Telling a patient, "yes, you have cancer. Before we treat you, however....we really need to find the root cause of your cancer. Once we figure that out -- maybe you have unresolved issues with your parents -- then we can treat your cancer." Eating Disorders are biologically based illnesses. The symptoms may present as "issues" or fear of fat, or love of excercising, but to focus on that is poor care. Please take the time to read current science on evidence based treatments.

Research does not support a single cause. We review studies on a regular basis and utilize evidence-based treatment interventions. A whole-person approach looks at every avenue for the benefit of the patient, including faith issues. As a certified eating disorder professional, as well as an approved supervisor, I am only interested in doing what is of help to those in need. May we team together, regardless of differences, to bring forth the very best results for those patients we care so much about.

Research does not support a single cause, but from your article it would seem that you do. The idea that abuse -- of any sort, overt or "unmet needs" -- is at the root of all eating disorders has no basis in the research. The only thing that all eating disorder patients share is their disorder.

We are ALL only interested in helping those in need. Yet we can only team together if we share basic principles based in good science and in the rapidly improving prognosis for patients that evidence-based treatment offers. Treatment based on underlying trauma and failed parenting is not supported by the literature. In fact, it is a sign of the kind of treatment the NIMH and APA and FEAST and AED actively reject.

It would be hoped that all treatments for any medical condition looked at the whole person, be it treatment for cancer, the common cold, or an eating disorder. I am pleased that you do look at evidence when it comes to treating eating disorders. I am unaware of any evidence that says that ALL who have an eating disorder have suffered abuse, or "unmet emotional needs". This implies the fault of another party be it a parent, friend or relative who has in turn caused the abuse or not met needs. People with eating disorders can come from the most loving idyllic home and back ground, may never have been subjected to any abuse. To suggest otherwise plays into some very old fashioned and debunked theories.

I thought it was a professional requirement to keep up to date with the latest research and knowledge in your professional field. I'm deeply disappointed to see Psychology Today publishing the ravings of a 'doctor' who clearly doesn't bother.
Have you missed all the latest research showing the heritability of eating disorders? Did you know there is a huge worldwide research study in progress right now, ANGI? (Google it. Google is your friend. Google scholar and Journal reading obviously hasn't been..)
Did you decide to just disregard it when patients told you they had not been abused in any way, but twisted it all to fit your theory? How arrogant of you.
And what the f are brain allergies?
My brain is certainly allergic to this crap.
I'm highly shocked that Psychology Today publishes this sort of damaging, dangerous and highly offensive twaddle.

Dear Dr. Jantz,
I read your post with interest, as the ideas you propose seem out of sync with the field's current knowledge about eating disorder etiology (which, I might add, is sparse). Idiosyncratic views tend to capture my attention. I have read the previous comments, and it is clear your post has kicked the hornets' nest, while your responses have done little to appease those concerned about the implications of your views.
I am withholding judgment, for now, as I believe an important detail of this conversation has been under-examined.
Many of your critics are parent-advocates whom I know and respect, and I am not surprised that they have bristled at being called "abusive". That being said, any of us fortunate enough to be a parent knows that we parent imperfectly, despite our best intentions. Leaving some emotional needs unmet is, I suspect, a misstep that every parent makes, to some degree.
So, if you would be so kind, could you please clarify your view that "unmet emotional needs" can play a causal role in eating disorder onset? What do you mean by "unmet emotional need". It is insufficient to simply state that "... [unmet emotional needs] give birth to the destructive practices of the eating disorder". What is the causal chain from such an unmet need to the development of an eating disorder?
I look forward to your reply.
Omar Canosa

Researchers, for many years, suspected that abuse might play a role in the development of anorexia nervosa. However, the abuse hypothesis has been almost entirely discarded within the community of scientists and researchers who are well-informed and up-to-date.

People who are interested in this topic might want to read the review paper that was published in 2004 by Jacobi, et al. entitled Coming to Terms with Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy, Psychol Bull 2004 Jan: 130 (1): 19-65. Jacobi discussed in her review paper more than 200 research studies that have attempted to examine the causes of eating disorders. She concludes that not one of those studies has proven that abuse plays a causal role. Of course, some people with eating disorders have been abused. But many people with eating disorders have not been abused. And many people who have been abused have not developed an eating disorder. The best available scientific data indicates that abuse and eating disorders are independent, and that rates of abuse are no higher among the eating disorder population than among the non-eating disorder population.

If Mr. Jantz is able to substantiate his claim that abuse is "at the root of all" eating disorders, then he has discovered something that the best, most highly skilled, scientific researchers around he world have been unable to find despite decades of research and millions of dollars spent on research studies. I invite Mr. Jantz, therefore, to publish his data in a reputable, peer-reviewed scientific journal, so that the rest of the world can see the basis of his statement and decide whether he is reliable or whether, on the other hand, he should not be trusted.

If you would like to read the book from which this blog post was excerpted, I am happy to share it with you. To request a complimentary copy, click on the link below. Scroll down to the Contact form. In the Message box, state that you would like a copy of Hope and Healing From Emotional Abuse, followed by your mailing address.

I'm afraid this evasive response by Mr. Jantz simply confirms the conclusion that he is not an authority on eating disorders and is motivated by commercial interests, including sales of his books.

Unfortunately, the eating disorders profession is plagued by many problems. A majority of eating disorder treatment providers themselves have psychiatric difficulties and suffer from emotional burnout. Most are unable and unwilling to base treatment approaches on evidence or logic. Many fail to keep current with research and use methods they find interesting or enjoyable rather than those that have been proven to be effective. Several studies confirm the existence of these dysfunctional aspects of the eating disorders treatment profession, including Warren, A Qualitative Analysis of Job Burnout in Eating Disorder Treatment Providers, http://www.ncbi.nlm.nih.gov/pubmed/22519896
Von Ranson, Psychotherapies Provided for Eating Disorders by Community Clinicians: Infrequent Use of Evidence-Based Treatment, http://www.ncbi.nlm.nih.gov/pubmed/23088433 and
Cook, Apples Don't Fall Far From the Tree: Influences on Psychotherapists' Adoption and Sustained Use of New Therapies,
http://www.ncbi.nlm.nih.gov/pubmed/19411356

People who suffer from eating disorders, and their families, need to be very careful about whom they choose, if anyone, to help them recover from anorexia nervosa or other clinical eating disorders.